how to afford and fund automated transport systems … · how to afford and fund automated...

HOW TO AFFORD AND FUND AUTOMATED TRANSPORT SYSTEMS IN TODAY’S ECONOMY September 21st, 2011 1:30pm- 3:00pm Room Seven

Presenters

Vice President Healthcare HOK Inc. 60 East Van Buren Street, 14th floor Chicago, IL 60605 USA 312-254-5388 (phone) Email: [email protected]

Vladislav Torskiy I.AIA, AEAI,

LEAN Healthcare CP

Principal/Owner DesignLogics 160 W. 5th Ave. Columbus, OH 43201 USA 614‐271-6985 (phone) Email: [email protected]

Sarah Mueller LEED AP

mailto:[email protected]

mailto:[email protected]

Presenters

President TransVac Systems 1835 Blake St. Denver, CO 80202 USA 303-327-8185 (phone) Email: [email protected]

Harry Pliskin JD

Director of Distribution Services The Ohio State University Medical Center 410 W. 10th Ave. Doan Hall Columbus, OH 43210 USA 614-293-2226 (phone) Email: [email protected]

Carl Story CMRP

Learning Objectives • Robotics & Artificial Intelligence for Healthcare

• What is it…. Robotics & Artificial Intelligence? • Automated Guided Vehicle (AGV) system cost benefit

analysis • Pneumatic Waste Removal (PWR) system cost benefit

analysis

• Case Study Review • The Ohio State University Medical Center • Finances… From Acquisition to Payback

• LEAN Implementation for Healthcare Operations

THE OHIO STATE UNIVERSITY Site

OSUMC- Site

RESEARCH

RESEARCH RESEARCH

PATIENT CARE

PATIENT CARE

PATIENT CARE

EDUCATION

EDUCATION

EDUCATION

OSUMC- Site

AUTOMATED GUIDED VEHICLES Healthcare AGV 101

AGV- Healthcare

http://www.jbtc-agv.com/

Service Carts Transport Vehicles Battery Chargers Laser Bumpers Cart Washers Control System PC Terminals Pocket PC Pagers RFID Elevators Automatic Doors

AGV- Healthcare


Type: Lift Deck Cart Carrier Dimensions: 65 in L x 24 in W x 81 in H Weight: 990 lb (incl. Battery) Max Payload: 1,000 lb Lift Stroke: 3 in. Max. Speed (forward/reverse): 238 FPM Guidance Method: Laser Navigation Features: - rugged design - 3-wheel design with * 1 drive/steer unit * 2 fixed follower casters - bi-directional - WLAN communication - load verification: barcode Safety System: - Laser Bumpers front + rear - bumper strips on both sides - audio-visual signals

AGV- JBT Corp.


Type: Lift Deck Cart Carrier Dimensions: 78 ¼” L x 23 ¾” W x 15” H Weight: 900 lb (incl. Battery) Max Payload: 900 lb Lift Stroke: 2 3/8 in. Max. Speed (forward/reverse): 250 FPM Features: - rugged design - 4-wheel design with * 2 integrated drive units (diagonal mounting) * 2 casters (opposite diagonals) - fully bi-directional - grid navigation Safety System: - Laser Bumpers front + rear - bumper strips on both sides - audio-visual signals - software watchdogs

AGV- Frog/DS Automation

Type: Lift Deck Cart Carrier Dimensions: 66.14” L x 24.25” W x 13.4” H Weight: 550 lb (incl. Battery) Max Payload: 1,000 lb Lift Stroke: 2.35 in. Max. Speed (forward/reverse): 390 FPM Features: - rugged design - 4-wheel design with * 1 drive/steer unit (front) * 1 non-drive steer wheel (rear) * 2 fixed side wheels (center) - fully bi-directional - contour following navigation Safety System: - laser bumpers front + rear - bumper strips on both sides - audio-visual signals

AGV- Swisslog

o Reduce Operating Costs o Separate Patient and Material

Pathways o Reduce Cart Clutter o Improve Cleanliness o Integrate Operations o Load Tracking & Accountability o Improve Support Department

Operations o Reduce Worker’s Compensation

Claims o Reduce Building Damage by Carts o Eliminate Elevator Damage by Carts o Reduce Staff/Patient Elevator Wait

Time o Rapid Material Delivery/Removal o Increase Patient Satisfaction

AGV- Healthcare Benefits


Transporter Vehicles Wireless

Handheld

ATS Hospital Terminal

Operator Touchscreen

Elevator/Lift Controls

Master Console

Wireless RF

Network

Pagers

Ethernet

AGV- How It Works

AGV- Master Control Center

The transporter recalculates its exact position several times per second based on the laser signal returned from wall mounted reflectors. This is how it stays on the Guidepath.

Reflector

Reflector

Reflector

The Guidepath is a path where the vehicle has been programmed to travel.

AGV- How It Works (Laser Guided)

The Guidepath is a path where the vehicle has been programmed to travel.

AGV- How It Works (Magnet Guided) The transporter recalculates its exact position several times per second based on magnets in the floor. This is how it stays on the Guidepath.

AGV Vehicle Circulation

Zone

AGV Vehicle Pick-Drop Position

Staff Delivery Route

Off Carts Staging Position

AGV Vehicle Entrance Position

AGV Vehicle Exiting

Position

Automatic Transportation System (ATS) - Automatic Guided Vehicles (AGV)

AGV- How It Works

OSUMC Evolution of Operations

Operations and Logistics: Methods of Delivery

Supply Coordinator

Manual Labor

AGV System & Floor Supply Coordinator

Rail System and Manual Labor

AGV System

AGV System & PWR System


The Ohio State University Medical Center

Overhead Rail System

o Existing 25-year old system o System occupied tremendous floor space o Low reliability o System was costing more to operate that it

provided in labor savings

Overhead Rail System

Cost Justification

• Intense Competition for Funding

• Four Alternate Solutions Considered 1) Abandon the overhead rail and deliver carts manually 2) Replace current overhead rail with a new overhead rail 3) Replace the vertical portion of the overhead rail and manually push carts horizontally on patient floors 4) Install new ATS system

LINEN VENDOR

EVS SUPPLIES

MEDICAL SUPPLIES

FOOD SUPPLIES

MEDICAL EQUIPMENT IT

EQUIPMENT

3rd PARTY VENDORs

USPS / FEDEX

FURNITURE / OFFICE

EQUIPMENT $7.4M

$46.8M

$35.9M $2.9M $29.5M

$5.4M

$1.6M

Annual Spending (approx) = $130M


CLEAR WASTE

RED WASTE YELLOW WASTE

BLACK WASTE

HARD TRASH RECYCLABLES


Annual Spending (approx) = $5M

LINEN VENDOR

CLEAN SUPPLIES

MEDICAL SUPPLIES

FOOD SUPPLIES

MEDICAL EQUIPMENT

IT EQUIPMENT

3rd PARTY VENDORs

USPS / FEDEX

FURNITURE / OFFICE

EQUIPMENT

CLEAR WASTE

RED WASTE YELLOW WASTE

BLACK WASTE

HARD TRASH RECYCLABLES


Annual Total Spending (approx) = $135M

ATS Delivered…

o A four minute reduction in elevator wait time

o 95 employees returned back to patient care

o A savings of $65 million over 25 years

Cost Justification


Operational and Cultural Changes

Support Services w/AGV

Materials Management

Lab

Pharmacy

Central Sterile Supply

Nutrition Services

Distribution Services

Environmental Services

Linen Services


Learning an Employee Owned System

Staff Training – 1,500 staff • Open House Introduction • Basic Introduction 1-hour

Class • Detailed Classroom and

Hands-On Training


o Learning to see the AGV as a partner in operations o Distribution- new pallet architecture from

distributor o Environmental- timing of trash removal o Biohazard- see process from key source

points o Linen- reduce storage on floor o Hot Food- setting priorities o Case carts- carts called for individual cases

LEAN Process… Continuous Improvements

Comparison of 4 Major ATS Healthcare Operations

OSUMC System 1

Hospital A Hospital B Hospital C

Beds/Discharge 900/56,800 900/40,400 1,100/51,000 900/55,500

Warehouse Vendor JIT Off-site DC On-site DC Off-site DC User Depts. All All, except

Dist. & Pharm. All, except

Case Carts All, except

Linen & Frozen Food

Surgical Case Cart Dispatch

Automatically Called by

ORIS

Push from CSS to OR storage

N/A Push from CSS by surgery type

Off-line Cart Staging

In Patient Floor AGV

Room

Patient Floor Rooms by Dept.

None Chute/Attended

In Patient Floor AGV Room

Dedicated Cart Delivery Staff

None 14 30 NA

Dedicated AGV Mgt Staff

Mgr., Engr., & Techs (6)

Mgr, Dispatch (3), Techs (3)

Mgr. NA

AGV Maintenance Vendor (2) Hospital (4 - not dedicated)

Vendor (2) Vendor (1)

Comparison of 4 Major ATS Healthcare Installations

OSUMC System 1

Hospital A Hospital B Hospital C

AGV Movement Horiz. & Vert. Horiz. & Vert. Horiz. Only Horiz. & Vert.

Cart Moves/Day 2400 3400 4800 1400

Vehicle Qty. 46 46 81 26

Charger Qty. 11 17 60 12

Elevator Qty. Single/Double

8/1 10/1 0/0 10/1

Cartwasher Qty. 2 2 2 3

Cart Types/Total

9/900 8/500 13/1050 8/600

Dispatch locations/ positions

58/252 54/299 20/216 55/463

Avg. Delivery 9 minutes 12 minutes 14 minutes 17 minutes

Delivery Notification

Pager/escalates Arrival Light

Pager, Pocket PC

Arrival Light

Pocket PC Arrival Light

PNEUMATIC WASTE REMOVAL What’s Next? Healthcare PWR 101

PWR for Waste, Soiled Linens, and Recyclables

o Lowers the costs substantially o Operates in a fully sealed manner

o Eliminates bottlenecks and improves throughput

Fan Room

Central Collection Plant

Central Processing and Monitoring

Air Intake

Air Exhaust

Trash in

Trash out

Velocity monitoring

How It Works

PWR- Components

System FAST FAQs

PWR- Reasons to Use Automated Collection

o Significant cost savings – Minimal staff required to operate and maintain the automated system; reduced labor delivers significant cost savings.

o Minimized exposure to infected materials - Facilities are cleaner and potentially hazardous working conditions are minimized as waste and soiled linen handling and public exposure is limited.

o Increases hospital space– Space currently absorbed by waste & linen carts can be allocated for more productive uses.

o Simplifies logistics– Significantly fewer people involved in the process of handling materials.

PWR Labor Comparison Traditional Removal vs. PWR Automated System

A typical

hospital will

reduce FTE

requirements by

75% using PWR

PWR

= Manual Collection

1344 minutes TOTAL EXPOSURE TIME

= Automated Collection 132.00 minutes TOTAL

EXPOSURE TIME

(based on 2 tons/day)

Exposure Comparison Limited Exposure Less Infection

(based on 2 tons/day)

Operation Function Manual Transport PWR

FTE required to transport soiled linens, trash and recycling through out hospital to final collection point

$30,347 $0

FTE Benefits at 50% $15,173 $0

Cart replacements (fleet of 60 replaced 1 time/3 years) $1,833 $0

Cart repairs (replacement parts and labor) $500 $0

Repairs from required wear & tear on interior spaces (walls, doors, elevators) $3,000 $0

Infection Control $4,500 $0

Life safety issues (workers comp, lost days) $3,000 $0

TOTAL $59,241 $0

PWR Resulting ROI- Cost Benefits Analysis

PWR Resulting ROI- Cost Benefits Analysis

Operation Function Manual Transport PWR

Upfront Capital Costs $500,000 $2,000,000

Net Upfront Capital Costs $1,500,000

TransVac Maintenance - Annual $15,000

Annual Manual Operating Expense $59,241

5 Year Operating Expense $3,540,000

10 Year Operating Expense $7,080,000

Payback in Years for TransVac 2.1 Years

Payback in Years for TransVac

2.1 Years

PWR systems turns

the removal of waste, linen and

recycling into a new source of cost

savings, value, & bottom-line

improvement

PWR- Cost Benefit Analysis Savings Over 25 Years

$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

0 5 10 15 20 25 30

TransVac 1 Riser

Manual + Gravity Chutes

Manual + Elevators

$25+ Million in Savings

Providing Solutions Through Constant Consultation

Project Manager / Consultant

Client

Contractor

Operational Partner

Jointly analyze operations & alternatives. Define capital & operational targets.

Project management updates and coordination.

Make adjustments as necessary.

Provide contractors with necessary drawings.

Timely delivery within GC or Owner’s schedule.

Client Consultation

Design

Engineering

Installation

Project Mgmt Proposal

Concept Commissioning

Training

Maintenance

Operation

Design Flexibility and Delivery

LEAN Process Applied…. Healthcare Operations

LEAN- Methodology / Process Applied

• Leadership • Eliminate Waste • Act Now • Never-Ending

LEAN

Process

Culture

Leadership

LEAN

LEAN Implementation


Primary Process

Internal Process

Process


Valuable

Capable

Available

Adequate

Flexible

Linked to Flow


LEAN – 7 Categories of Waste

Waiting

Transport

Processing

Inventory

Motion

Process Improvement

Correction

Overproduction


Patient

Vision

Mission

Values

Strategies

People Quality Service Innovation

Lines of Service, Prioritized

Institution

Healthcare System



Supply Coordinator

Manual Labor

AGV System & Floor Supply Coordinator

Rail System and Manual Labor

AGV System

AGV System & PWR System



H O S P I T A L H O S P I T A L PATIENT UNIT PURCHASING

V E

N D

O R

S

DOCKS MATERIAL SUPPLY ELEV PATIENT UNIT

1. DISTRIBUTION CENTER (Emergency Supplies)

2. ALL DELIVERIES (In Pallets)

BREAK DOWN

BREAK DOWN

STOCK WARE-HOUSE

CART PICKUP/

DROPOFF

CART PICKUP/

DROPOFF

STOCK

Stock Patient Rooms

DELIVER

Unload Carts into

Supply Rooms

PROCESS

Receive & Process Orders

SUPPLY

Visual Check-up/

Count Supplies

ORDERS

Nurse Faxes Orders

PURCHASING

Get Approval & Place Order to Vendor

SUPPLY FLOW MAP

VALUE ADDED MAP

nurse

PREPARE CARS

PREPARE CARTS

STOCK WARE-HOUSE

Supply staff delivers carts to

floor using service elevators

Nurse has to place orders manually

using Fax

supply staff

nurse

Manual Delivery System


H O S P I T A L H O S P I T A L PATIENT UNIT PURCHASING

V E

N D

O R

S

DOCKS MATERIAL SUPPLY ELEV PATIENT UNIT

1. DISTRIBUTION CENTER (Emergency Supplies)

2. INDIRECT DELIVERY (Prepackaged - In Pallets)

3. DIRECT DELIVERY (Prepackaged for Unit)

BREAK DOWN

BREAK DOWN

STOCK WARE-HOUSE

AGV PICKUP/

DROPOFF

AGV PICKUP/

DROPOFF

AGV PICKUP/

DROPOFF

STOCK

Stock Supply Rooms

DELIVER

Carts unloaded from AGV into store

room

PROCESS

Receive & Process Orders

SUPPLY

Visual Check-up/

Count Supplies

PURCHASING

Get Approval & Place Order to Vendor

SUPPLY FLOW MAP

VALUE ADDED MAP

PREPARE CART FOR

AGV

PREPARE CART FOR

AGV

Floor Supply Coordinator Checks/ Orders/ Tracks/ Stocks

Use of Bar “Code” and Electronic

Inventory

Floor Supply Coordinator

Floor Supply Coordinator

Dedicated AGV Elevators

MM staff does not have to follow and

unload AGV carts on floors

nurse nurse tech Floor Supply Coordinator Floor Supply Coordinator

Supply Coordinator stocks Supply

Room

Supply Coordinator stocks Nurse Server

in Patient Room

AGV/Floor Supply Coordinator System


OSUMC The Future of Operations

OR’s / Procedural Services: 60 Total Invasive RM

Diagnostic Services: 60 Total Diagnostic

Gantries

Emergency Services: 50 Patient Beds

Inpatient: 919 Total IP Beds

Outpatient:

347 Total Exam Rooms

OSUMC- Existing Service Compliment

• 85,000 – 110,000 pounds of incoming materials per day

• 6,000 – 8,000 pounds of

materials movement per hour

• One 53 footer at a time

• Street back-up and waiting

• No 30 footer and vans accommodation

• Dock positions converted to

storage

Receiving 5 docks

Waste 1 Compactor

OSUMC- Existing Loading Dock

OSUMC- Existing Service Plaza

Existing Medical Center Distribution Center & Service Plaza

OSUMC- Existing Dock Study

Perspective View from the South Plaza

The Ohio State University Medical Center- 2014

Emergency Services: +48 Patient Beds

Inpatient: +420 Total IP Beds

Outpatient Clinics:

+158 Total Exam Rooms

OR’s / Procedural Services:

+23 Total Invasive RM

Diagnostic Services: +7 Total Diagnostic

Gantries

Proposed Medical Center Expansion Functional Summary

OSUMC- Future Clinical Expansion

Summary of Medical Center:

AGV System:

76 Transporters 1,300 AGV Carts 73 Service Points

45 Battery Charging STA 16 AGV Elevators

4 AGV Cart-washers 4,000 Cart Moves per Day

168% Magnitude of

Expansion

Future Medical Center ATS Implementation Functional Summary

Summary of Medical Center:

AGV System:

76 Transporters 1,300 AGV Carts 73 Service Points

45 Battery Charging STA 16 AGV Elevators

4 AGV Cart-washers 4,000 Cart Moves per Day

168% Magnitude of

Expansion

OSUMC- 2014 Medical Campus

- CLINICAL CIRCULATION - PUBLIC / VISITOR CIRCULATION - AGV CIRCULATION

OSUMC- Ground Floor Circulation

• 130,000 – 170,000 pounds of incoming materials per day • 10,000 – 12,000 pounds of materials movement per hour • Six 65 footers at a time

• All vehicles access DC simultaneously

• 96 hours of supplies stored on-site JIT

Proposed Service Plaza and Distribution Center

OSUMC- PWR

OSUMC- Future Dock Study


OSUMC- Typical Diagnostic & Treatment Floor


OSUMC- Typical Patient Care Floor

Trash Removal

Confidential Material Vendor

Special Waste Vendor

Special Waste Vendor

Linen Vendor

H O S P I T A L PATIENT UNIT PATIENT

FLOOR ELEV SERVICE FLOOR WASTE MANAGEMENT DOCKS

1. SOILED LINEN

2. General Waste/Recycle/Biohazard

Operations and Logistics: A3 Supply Flow Diagram – IP Tower / D&T

Drop

Bags dropped in Soil rooms

EVS staff / nurse tech

Pickup

Bags picked up from Soil

rooms in carts

Load

Soiled Carts parked for

AGV pickup EVS staff

Drop

Bags dropped in AGV rooms

Pickup

Bags collected in carts in AGV room staging

Load

Soiled Carts parked for

AGV pickup EVS staff

Unloading

Soiled Carts unloaded from AGV

Unloading

Trash Carts unloaded from AGV

Sorting

RMW (Red)

RMW (Yellow)

TRASH

Trash Compactor

RECYCLE (HIPPA)

Vendor Upload

Vendor Upload

Vendor Containers

Vendor Containers

Vendor Upload Vendor Containers

VALUE ADDED MAP

Trash stays in Patient care area for long

time

Waste & Linen Carts occupying space on Patient floor waiting for scheduled EVS

pickup

Mixing of Waste Types

Extra space & labor needed to

sort - $$$

Load on Elevators /

AGV system

AGV

AGV


Equipment/D

istribution

Clinical

Engineering

IV Solution

UPS/FedEx/

USPS

Miss.

Sharps

FNS

EVS Supply

Specialty

Beds

Donation

Medical

Supply

Clean Linen

Medication

Rx

Lab

Medical Gas

Proposed OSUMC Waste Management & Service Plaza Functionality - OUT

Secure Waste

Hard Waste

Compost /

FNS

Specialty

Beds

Soiled Linen

Regulated

Medical

Waste

Yellow

Medical

Waste

Cardboard

Soiled Sharps

Recycling

Trash

Recyclables

Donation

Soiled

Equipment &

Instruments


Pneumatic Waste and Soiled Linen Removal (PWR) Process: year 2014 Concept


H O S P I T A L PATIENT UNIT PATIENT

FLOOR ELEV SERVICE FLOOR WASTE MANAGEMENT DOCKS

1. SOILED LINEN

2. General Waste/Recycle

3. Bio-Hazard Waste

RMW Waste

Removal

Waste Removal

AGV & Pneumatic Waste Removal (PWR) System Integrated (Future)

EVS staff / nurse tech

Drop

Linen Chute in Soiled

rooms

Drop

Trash & Recycle Chutes in

Soiled rooms

Linen Vendor

Trash Compactor

Collect

Soiled Linen bags collected into linen

carts

Collect

Trash received into compactor

Collect

Recycle received into compactor

Recycle Compactor

Pickup

Bags picked up from EVS

in carts

Load

Carts parked for AGV pickup

EVS staff

Unloading

Carts unloaded from AGV at Soiled Dock for vendor pickup

AGV

Drop

RMW (Red) in Soil Rooms

Drop

RMW (Yellow) in Soil Rooms

Pickup

Special Protocol

EVS staff

Parked

Carts parked in loading zone

Upload

Waste types disposed off separately

VALUE ADDED MAP

Reduced load on AGV System and

AGV Elevators

Waste Compacted

and Removed quickly

Special handling of bio-hazard

waste

AGV

Load

Carts parked for AGV pickup

Parked

Carts parked in loading zone

AGV

AGV


Proposed PWR Route The Ohio State University Medical Center

Proposed PWR at Loading Dock


COST BENEFIT ANALYSIS The Ohio State University Medical Center

• ROI Case Study

Life Cycle and Return on Investment – Cost Breakdown

AGV System Cost Breakdown – Upfront Investment

AGV Elevators

Auto Doors

Carts

Cart Washers

AGV Vehicles

Battery Chargers

Total AGV System Budget

AGV Controller

s

AGV System Cost Breakdown – Upfront Investment

AGV Elevators

Auto Doors

Carts

Cart Washers

AGV Vehicles

Battery Chargers

Total AGV System Budget

AGV Controller

s


PWR System Cost Breakdown – Upfront Investment

Pipes

Valves

Inlets

Collectors Diverters

Fans Scrubber

s Motors Electrical

IT Controls

Total PWR System Budget


25 Year Life Span of a System – Direct Cost

Data, per 11 AGV Vehicles Eliminated

Elevator

Battery

Caster

Cart Washer

AGV Vehicle

Preventive Maintenanc

e

Capital Improvements Annual Reserve - System Individual Elements Replacement


25 Year Life Span of a System – Direct Cost

Pipes

Valves

Inlets

Containers

Mechanics

Electrical Controls



Life Cycle and Return on Investment – Cost Breakdown 25 Year Life Span of a System – Indirect Cost

Benefits

Injury

Staff Sick Days

Air Quality

LABOR


PWR System Payback Period

# Expense Unit 1 AGV system cost reduction due to PWR installation $ 2 PWR System up-front investment $ 3 PWR System associated construction cost $

DELTA $

4 AGV system life cycle cost per year $ 5 PWR system life cycle cost per year $

DELTA per YEAR $ Pay back period in years (without operational

considerations)

AGV vs. AGV+PWR Systems Comparison


SUMMARY What did we learn?

QUESTIONS?

PRESENTERS Sarah Mueller, DesignLogics Vlad Torskiy, HOK Harry Pliskin, TransVac Carl Story, OSUMC

how to afford and fund automated transport systems … · how to afford and fund automated...

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